Blood oxygenation device

ABSTRACT

A BUBBLE OXYGENATION DEVICE WHICH INCLUDES A CYLINDRICAL OXYGENATORR CHAMBER CONNECTED IN SERIES WITH A DEFOAMING CHAMBER AD A SETTLING CHAMBER, AND AN OXYGEN DISPERSER MEMBER FOR DELIVERING OXYGEN AND VENOUS BLOOD TO THE OXYGENATOR CHAMBER, THE DISPERSER MEMBER BEING SLIDABLE IN THE OXYGENATOR TO CONTROL THE OXYGENATION CAPACITY THEREOF.

Aug. 6 1974 w, BURUS v 3,827,860

BLOOD OXYGENATION DEVICE I Filed June 15, 1972 2 Sheets-Sheet 1 Aug. 61974 N. w. BURLIS BLOOD OXYGENATION DEVICE 2 Sheets-Sheet m Filed June15, 1972 3,827,860 BLOOD OXYGENATION DEVICE Norbert W. Burlis,University City, Mo., assignor to Sherwood Medical Industries Inc., St.Louis, Mo. Filed June 15, 1972, Ser. No. 263,049 Int. Cl. A61m 1/03 US.Cl. z3-2ss.s 15 Claims ABSTRACT OF THE DISCLOSURE BACKGROUND OF THEINVENTION This invention relates to blood oxygenation devices, and moreparticularly to blood oxygenators used to perform the function of thelungs during surgery, such as cardiac surgery.

Reference is hereby made to US. Patents, Nos. 2,854,- 002 and 3,112,746,which disclose blood oxygenation devices of the bubble type and a bookby P. M. Galletti and G. A. Bocher, entitled Heart-Lung Bypass publishedby Grune & Stratton of New York, NY, which describes bubble-type as wellas various other types of oxygenating devices.

Oxygenation devices of the bubble-type for use in extracorporealcirculation generally include an oxygenator chamber into which venousblood and gas bubles are introduced, a defoaming chamber for removingbubbles and filtering the blood, and a settling chamber for removing anyremaining bubbles and serving as a reservoir for the oxygenated blood.Blood is pumped through the system at a flow rate determined primarilyby the size of the human or other animal through which the blood iscirculating.

There has been certain disadvantages or undesirable features associatedwith blood oxygenation devices in the past. For example, because ofvarious design requirements, such as oxygenation capacity or adequateoxygenation at an adequate blood flow rate, avoidance or minimization ofthe destruction of blood elements due to the mechanics of theoxygenation device, gas pressures, bubble size, etc., it has beennecessary to make oxygenation devices in different sizes, that-is, withdifferent xygenation capacities. The cost of such devices is relativelyhigh because it is, of course, relatively expensive to manufacture avariety of different sizes. Also, during surgery, ,blood monitoringdevices may indicate that a change in oxygen content is required.Accordingly, the oxygenation or bubbling chamber of plastic bag typeoxygenators is sometimes reduced in size, such as by pinching thechamber with external clamps. This is not a very precise manner ofchanging the oxygen content of the blood, and is not repeatable withaccuracy. On the other hand, when the monitoring devices indicate thatan increase in oxygenation level is desired, it is generally necessaryto change the gas mixture since increasing the gas pressure might causedamage to the blood elements while not materially increasing the oxygencontent due to the increased flow rate in the bubbling chamber. Changingthe gas mixture, for example, to increase the ratio of oxygen to carbondioxide, also of course has the effect of changing the carbon dioxideretention and elimination. In general, each oxygenator had certaindesign characteristics for providing optimumservice that necessarilylimit the degree of nitcd States Patent 0 ice variation in operatingconditions or parameters, such as the blood flow rate. 1

SUMMARY OF PRESENT INVENTION It is therefore an object of the presentinvention to provide an improved blood oxygenation device wherein theabove mentioned disadvantages are substantially obviated.

Another object is to provide an improved blood oxygenation device whichis capable of efiicient operation through a wide range of blood rtlowrates.

Another object is to provide an efficient blood oxygenation device whichis especially simple, economical, highly efiicient in operation, andwhich can be readily adjusted so that a single size can be used forhumans or other animals of various sizes.

Still another object is to provide a novel oxygenator chamber andoxygenating gas disperser for use in an extracorporeal circulationsystem which readily permits stepless or minute, as well as relativelylarge, adjustments before and/or during use so as to provide eflicientoxygenation of the blood for a wide range of blood flow rates.

Yet another object is to provide an economical oxygenator for use in anextracorporeal system wherein the oxygen content of the blood can bereadily changed through a wide range of levels without undesirablyaffecting other characteristics of the oxygenation system.

In accordance with one form of the present invention, an oxygenationdevice is provided which includes a chamher for receiving blood to beoxygenated and an oxygenating gas, and a member for varying the locationat which the gas is introduced into the chamber to control the time thatthe blood is in contact with the gas.

These and other objects and advantages of the present invention will beapparent from the following detailed description and accompanyingdrawings.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a perspective view of anoxygenation device in accordance with one embodiment of the presentinvention;

FIG. 2 is an elevational sectional view of the device of FIG. 1;

FIG. 3 is a cross-sectional view taken from line 3-3 of FIG. 2; and

FIG. 4 is an enlarged fragmentary view of the oxygenator chamber and gasdisperser of FIG. 1.

DESCRIPTION OF THE PREFERRED EMBODIMENT Referring now to the drawings,and particularly to FIGS. 1 and 2, there is shown a blood oxygenationdevice 10 of the bubble-type which can be used in an extracorporealcirculation system for simulating the function of the lungs duringsurgery, such as cardiac surgery. The oxygenation device 10 includes apair of flat sheets 12 and 14 of a plastic material, for example, athermoplastic material, such as polyvinyl chloride, united to form aseries of compartments or chambers 16 through the sheet. An externaloxygenator 18 is connected to the chambers.

The sheets 12 and 14 are united preferably by heat sealing along linesoutlining or defining the chamberslfi illustrated in the drawing.Chamber 16 defines a deforming compartment or chamber 20 and a settlingor reservoir compartment or chamber 22 between the sheets. The defoamingchamber 20 has an inlet 24 connected to the upper end of the oxygenator18, and amain defoaming portion 26 connected in fluid flow communicationwith the settling chamber 22. The main defoaming portion 26 contains adefoaming member 28 disposed within a filter member 30. The defoamingmember 28 may be a suitable antifoaming material such as plastic fibers,metal fibers, etc., which is coated with any well known suitableantifoam agent, such as conventional silicon fluids. Filter 30 is in theform of a sleeve which may be made of a porous material such as nylon.The defoaming member 28 is shown disposed within the filter sleeve 30and positioned in the main defoaming portion 26 and held therein byuniting the sheets such as indicated at 32. The device is provided witha gas outlet or vent 34 for venting gas, including excess oxygen andcarbon dioxide, from the blood. The vent 34 is above and in fluidcommunication with the defoaming chamber and settling chamber 22 so thatany bubbles or gas eminating from these chambers are vented to theatmosphere.

The settling chamber 22 is provided with an outlet indicated at 36 whichhas connected thereto an outlet tube indicated at 38 which may beconnected thereto by cutting one layer, such as layer 12, and heatsealing the plastic tube entirely around its periphery at the outlet sothat tube 38 is sealed to sheets 12 and 14 and in fluid communicationwith chamber 22.

The sheets 12 and 14 are shown provided with a plurality of holes 39 forthe purpose of supporting the oxygenation device 10, as well asattaching other apparatus thereto during use. The oxygenation device ispositioned such that the outlet 36 of the settling chamber is at thebottom and the defoaming chamber 20 is at the top, for example, as seenin FIG. 2 of the drawings.

The oxygenator 18 includes a hollow member 44, shown cylindrical, whichprovides an oxygenator chamber or column 46, and a movable oxygenationgas disperser or diffusion member 48. The device 18 is shown alsoincluding a releasable holding member 50, illustrated as a releasableclamp, disposed externally of the chamber 46 which may be used wheredesired or required for holding or clamping the movable disperser 48 ina desired position within chamber 46.

The oxygenator member 44 is shown formed of a plastic material, forexample, from plastic tubing, which is preferably flexible but may berigid if desired. Preferably the member 44 is formed of a suitableflexible plastic, such as polyvinyl chloride, or polyurethane, and suchthat it is circular in cross-section when not collapsed or stretched andis, furthermore, preferably formed as a separate member distinct fromthe plastic sheets 12 and 14, as seen in the drawing. The member 44 isalso preferably formed seamless, such as by producing it by extrusion,to provide a smooth surface to readily obtain a fluid tight seal withmember 48. The upper end or outlet of oxygenator chamber 46, indicatedat 52, is connected, as seen in FIG. 3, to the inlet 24 of the defoamingchamber 20 by cutting the layer 12, inserting the end 52 into theopening formed thereby and securing such as by cementing or heat sealingentirely around the tubular member 44 to form a fluid tight connectionbetween the oxygenator chamber 46 and the defoaming chamber 20. In thedrawing, the oxygenator chamber 46 is shown extending vertically and thedefoaming chamber 20 connected thereto is shown extending angularlydownwardly therefrom.

The oxygenation gas disperser 48 is slidable in oxygenator chamber 46and is in fluid tight sealing engagement with the walls of the chamber.As seen in greater detail in FIG. 4, the disperser 48 is in the form ofa hollow piston-type member formed of suitable plastic material such asacrylic. The disperser is shown including a lower circular housingmember 56 connected, such as by cement or by heat fusing, to an uppercircular gas dispersing plate 58. Housing 56 has a cylindrical side wall60 defining with the plate 58 an internal gas chamber 62. The outersurfaces of members 56 and 58, which are indicated respectively at 64and 66, are in sealing slidable engagement with the walls of theoxygenator chamber 46 to seal and prevent blood above the dispersermember 48 from flowing downwardly past the disperser member.

The upper disperser plate 58 includes a plurality of holes 70 which areof small diameter, for example, .006 of an inch, for efficientlydistributing gas introduced into the disperser chamber 62 into theoxygenator chamber 46. Gas is introduced into chamber 62 by means of aplastic tube 72 connected such as by cement in an opening 76 in thehousing 56.

The disperser member 48 is also provided with a pair of openings 80 and81 disposed respectively in the housing 56 and upper plate 58 in alignedrelation with each other to receive a conduit or tube, such as a plastictube 83 adapted to be connected so as to supply venous blood through thedisperser member 48 to the oxygenator chamber 46. The upper end of tube83 may be connected to members 56 and 58 such as by a suitable plasticcement. The opposite end of tube 83, which is not shown, is connected toa body source of venous blood. Disperser member 48 is also shownprovided with another conduit or tube 85 which is similarly connected influid communication with chamber 46 through the member 48. Tube 85 maybe of plastic and is shown connected through aligned openings 86 and 87in the disperser member. Tube 85 may also be used to deliver blood tothe oxygenator chamber 46 for certain operative procedures.

The releasable holding device 50 is shown surrounding the tubular member44 and the disperser 48 for releasably securing the member 48 within thechamber 46. Holding device 50 is shown as including a clamping band 90and an adjustable screw-type ratchet or take-up 88 for tightening theband around the members 44 and 48. The holding device 50 may be of anysuitable type for holding member 48 in a desired location, for example,it may include an elastic member or a conventional hose clamp, or thelike. In some cases, the member 48 may be made of a size such that theclamping device is necessary to eflect sealing engagement between theinner chamber 46 and the member 48. The member 48 and chamber 46 may besized to effect a sliding, fluid tight friction fit therebetween so thata clamping or holding device such as device 50 is not required.

In operation, after the oxygenation device 10 has been primed by theintroduction of a suitable amount of priming blood into the system, oneor both of the plastic tubes 83 and 85 may be connected with a bodysource of venous blood to by oxygenated. Also, the plastic tube 72 isconnected with a source of oxygenating gas which may be pure oxygen oroxygen with a relatively small percentage of carbon dioxide; preferablythe gas is about 97% oxygen and 3% carbon dioxide. The plastic tube 83is connected to the patients arterial system. The extracorporealcirculation system, of course, includes a suitable blood pump formaintaining a flow of blood through the system.

Depending upon the size of the patient, the disperser member 48 will bemoved to a predetermined position within the oxygenator chamber 46 toset the oxygenator for eflicient oxygenation at a desired blood flowrate. As seen in FIG. 4, the outer surface of the tubular member 44 maybe calibrated, for example, in litres per minute. In this regard, itshould be noted that the oxygenation device may be shipped from themanufacturer with the disperser member 48 in its uppermost positionwithin the oxygenator chamber 46, for example, in its pediatricposition, so that the disperser member may be withdrawn to a desiredposition within chamber 46 by loosening clamp 50 where used, and pullingthe disperser downwardly by tubes 72, 83 and 85. If desired, however, arigid plunger rod (not shown) may be provided to assist in locating orrepositioning disperser 48 within chamber 46. Also, the member 48 may bemoved in some cases, in either direction by hand manipulating theexterior of member 44 adjacent the member 48. After the disperser member48 is positioned for the desired flow rate or oxygenation capacityrequired by the particular patient, the clamp 50, where used, isadjusted to tighten the clamp around the outer periphery of member 44and member 48 to secure the member 48 in the desired position, and,where required, to effect sealing engagement between the slida-bledisperser member 48 and the chamber 46.

' The oxygenation; gas flowing into the chamber 62 (FIG. 4) through thetube 72 flows through the small passages 70 in the dispersing plate 58and produces bubbles in the venous blood which is flowing into chamber46 by Way of tubes 83 and/or 85. The venous blood flows over the top ofdisperser plate 58 and the bubbles flow through the blood and cause theblood and gas mixture to rise and flow upwardly in the chamber 46 andthen into the defoaming chamber 20. The blood and gas bubbles produce afoam which flows into the anti-foaming material 28 and through thefilter 30 and the excess gas and carbon dioxide are vented to atmosphereby vent 34. As seen in FIG. 2, the filtering and anti-foam membersextend slightly below the operating level of the settling chamber whichis indicated by a line '89 in FIG. 2. Thus, the blood will not fall orsplash into the settling chamber 22 to cause bubbling and this aids inremoving and preventing the trapping of gas bubbles. The oxygenated orarterial blood in the settling chamber, after any further bubbles areremoved, flows into tube 38 and back into the arterial system of thepatient.

During continued operation, should it be desired to change the oxygencontent of the blood, the releasable holding means 50 is loosened andthe disperser 46 is moved in the desired direction to effect the desiredchange in oxygen content. For example, if body monitoring devicesindicate that an increase in oxygen content of the blood is desired,then the disperser member 48 is moved downwardly in the oxygenatorchamber 46 to increase the effective length of chamber 46 so that bloodflowing in the chamber 46 is subjected to the oxygenating gas for alonger time, that is, the blood will be travelling a longer distance inthe oxygenator chamber 46 and therefore be subjected to the gas bubblesover a longer period of time. On the other hand, if it is desired todecrease the oxygen content of the blood, for example, to avoid oxygenpoisoning or for any other reason, the disperser member 48 is movedupwardly in the chamber 46 to thereby decrease the dicetive length ofthe oxygenator chamber and decrease the length of time that venous bloodremains in the oxygenator chamber.

The oxygenator 18 is preferably of suflicient capacity to handle thegreatest flow rate of blood expected to be required for a human being orfor an animal. In this way, when the disperser member 48 is, forexample, near the lower end of the tube 44 it will provide a sufficientoxygenation capacity for the largest person or animal with which it isto be used. As the disperser member 48 is moved to the upper end of thesleeve 46, it, of course, provides effective oxygenation for very smallblood flow rates, for example, for pediatric patients.

The oxygenator 18 when made for use on humans, is preferably made toprovide efficient oxygenation for blood flow rates from about M4 litreper minute to 6 litres per minute so that it is useful for both adultsand children. This is accomplished in one design by forming theoxygenator chamber with an inner diameter of 2 inches and having alength of 6-18 inches and with the conventional gas flow rate of about2-3 times blood flow rate.

Movement of the disperser member 48 longitudinally in the oxygenatorchamber 46, as previously mentioned herein, varies the effective lengthof the chamber, that is, the distance between the member 48 and upperend portion of the chamber 46. In this way, the time that the blood isin contact with the oxygenating gas and, hence, the oxygen content inthe blood is thereby controlled or varied. Thus, the oxygenationcapacity or rate of blood flow during which elfective oxygenation isaccomplished can be readily varied or controlled. Not only does theoxygenator permit a single size to be used on patients or animals ofhighly diiferent sizes to obtain the economies thereof, but it providesmeans for readily varying the oxygen content of blood during surgery.The disperser member 48 provides for adjustment in the oxygen content,in a stepless manner by merely sliding member 48 in the oxygenatorchamber, and such adjustment can be relatively large or very small, asdesired or required. By having the capability of varying the oxygencontent of the blood in this manner during surgery, the physician isprovided with a very precise manner of changing the oxygen content whichcan be repeated easily since the tube 44 is preferably provided withgraduations or other calibration indicia. Use of a single sizeoxygenator avoids the chance of error in choosing a properly sizeddevice of the prior art type after surgery has begun. Also, varying theeffective length of the oxygenator chamber 46 by varying the position ofthe member 48 to vary the oxygenation capacity does not generallyrequire a change in the ratio of oxygen to carbon dioxide used or inother mechanical features of the apparatus. In addition, reducing theeffective length of the oxygenation chamber when it is desired to employit for use with a smaller person or child, also reduces the volumn ofpriming fluid required.

The design of the defoaming and settling chambers vary greatly and mayinclude various types of filters, bubble traps, vents, and so forth, asis Well known to those skilled in the art. The oxygenator 18 may ofcourse be used With various types of defoaming and settling chambers.

It should be understood that, although this invention has been describedwith reference to the illustrated preferred embodiment, modificationsthereto may be made without departing from the true spirt and scope ofthe invention.

What is claimed is:

1. A blood oxygenation device comprising an oxygenator chamber adaptedto receive blood to be oxygenated and an oxygenating gas, saidoxygenator chamber including a seamless plastic elongate tubular membernormally circular in cross-section, and means for introducingoxygenation gas and blood into said oxygenator chamber to produce amixture of rising blood and gas bubbles and for selectively varying thelocation at which said oxygenating gas is introduced into said chamberto control the length of time that blood introduced into said chamber issubjected to said gas to adjust the effective oxygenation capacity ofthe device in accordance with the oxygenation requirements of thepatient, said means including a member selectively slidably connected insaid oxygenator chamber and having passage means therein fortransmitting said gas from a supply to said chamber to produce said gasbubbles.

2. A blood oxygenation device for use in an extracor- -poreal bloodcirculating system comprising a pair of flexible plastic sheets, saidsheets being preselectively united to provide a blood defoaming chamberand a blood reservoir connected in fluid communication with saiddefoaming chamber for receiving oxygenated blood, anti-foam means insaid defoaming chamber for removing excess gas from the blood, and anoxygenator comprising a plastic tubular member defining an oxygenatorchamber having an upper end portion connected in fluid communicationwith said defoaming chamber, and means for introducing oxygenation gasand venous blood into said oxygenator chamber to produce a mixture ofrising blood and gas bubbles including a gas disperser memberselectively slidably connected in said oxygenator chamber to selectivelyvary the distance between said disperser member and said upper endportion for varying the effective length of said oxygenator chamber toadjust the effective oxygenation capacity of the device in accordancewith the oxygenation requirements of the patient, said disperser memberincluding upper and lower members defining a gas chamber adapted forconnection with a supply of oxygenation gas, said upper member having aplurality of relatively small openings therein for dispersing said gasand producing relatively small gas bubbles in the blood in saidoxygenator chamber, and means extending through said disperser memberfor connection with a source of venous blood to supply said venous bloodto said oxygenator chamber.

3. A blood oxygenation device for use in an extracorporeal bloodcirculating system comprising a pair of flexible plastic sheets, saidsheets being preselectively united to provide a blood defoaming chamberand a blood reservoir connected in fluid communication with saiddefoaming chamber for receiving oxygenated blood, anti-foam means insaid defoaming chamber for removing excess gas from the blood, and anoxygenator comprising a plastic tubular member defining an oxygenatorchamber having an upper end portion connected in fluid communicationwith said defoaming chamber, and means for introducing oxygenation gasand venous blood into said oxygenator chamber to produce a mixture ofrising blood and gas bubbles including a gas disperser memberselectively slidably connected in said oxygenator chamber to vary thedistance between said disperser member and said upper end portion forvarying the effective oxygenation capacity of the device in accordancewith the oxygenation requirements of the patient, said oxygenatorchamber being transparent and having indicia thereon to indicate therelative position of said disperser member therein.

4. A blood oxygenation device for use in an extracorporeal bloodcirculating system comprising a tubular oxygenator chamber having upperand lower portions, means for introducing venous blood and anoxygenating gas into said oxygenator chamber to produce a rising mixtureof blood and gas bubbles therein including a gas disperser memberdisposed within said oxygenator chamber in sealing slidable engagementwith the interior walls of said oxygenator chamber and slidable betweensaid upper and lower portions in a stepless manner by the user forvarying the oxygenation capacity of the oxygenation device in accordancewith the oxygenation requirements of the patient, said disperser memberincluding a gas dispersing wall having a plurality of gas dispersingpassages therethrough disposed within said oxygenator chamber, and meansfor connecting said gas dispersing passages with a source of oxygenatinggas, a defoaming chamber connected to said upper portion of saidoxygenator chamber to receive said mixture and release gas therefrom,and a reservoir chamber connected to said defoaming chamber to receiveoxygenated blood from said defoaming chamber and having outlet means fordischarging oxygenated blood therefrom.

5. The blood oxygenation device according to claim 4 wherein saidoxygenator chamber is of transparent material and said disperser membercan be viewed therethrough.

6. The blood oxygenation device according to claim 4 further comprisingmeans including indicia on the device to indicate the position of saiddisperser member along the length of said oxygenator chamber forindicating the setting of the effective oxygenation capacity of thedevice.

7. The blood oxygenation device according to claim 4 wherein saidoxygenator chamber is sized so that said movement of said dispersermember between said upper and lower portions changes the effectiveoxy-genation capacity of the device through a range of between aboutlitre of blood per minute to about 6 litres of blood per minute.

8. The blood oxygenation device according to claim 4 wherein said gasdisperser member has a bottom wall and a gas chamber between said gasdispersing Wall and said bottom wall, said means for connecting said gasdispersing passages with a source of oxygenating gas including tubemeans connected with said bottom wall and communicating with said gaschamber.

9. The blood oxygenation device according to claim 8 wherein said meansfor introducing venous blood and an oxygenating gas into said oxygenatorchamber further includes an opening in said gas dispersing wall, anopening in said bottom wall, and second tube means connectable to asource of venous blood and passing through said bottom wall opening andsaid gas chamber, and into said gas dispersing wall opening tocommunicate with said oxygenator chamber.

10. The blood oxygenation device according to claim 9 wherein saidsecond tube means terminates at the upper end thereof substantially inthe upper plane of said disperser wall so that venous blood enters saidoxygenator chamber at the upper surface of said disperser wall.

11. The blood oxygenation device according to claim 4 wherein said gasdisperser member is slidable along a longitudinal straight line over atleast a major portion of the length of said oxygenator chamber.

12. The blood oxygenation device according to claim 11 wherein saidoxygenator chamber is of transparent material, and the device hasindicia thereon for indicating the position of said disperser member insaid oxygenator chamber and thereby the effective oxygenation capacityof the device.

13. The blood oxygenation device according to claim 12 wherein saidindicia are disposed on said oxygenation chamber.

14. The blood oxygenation device according to claim 11 wherein saidmeans for introducing venous blood into said oxygenator chamber includestube means connected to said disperser member for movement therewith,said disperser member being slidable in said oxygenator chamber along alongitudinal straight line in either direction to increase or decreasethe oxygenation capacity of the device.

15. The blood oxygenation device according to claim 14 further includingreleasable clamping means exteriorly of said oxygenation chamberclamping the interior walls of said oxygenator chamber against saiddisperser member to releasably secure the same in a selected location.

References Cited UNITED STATES PATENTS 2,405,494 8/1946 Dupuy 55-255X2,854,002 9/1958 DeWall et al. 23-2585 3,488,158 1/1970 Bentley et al.23-2585 3,545,937 12/1970 Rozhold et al. 23-2585 3,729,377 4/1973Leonard 23-258.5 Re. 27,100 3/1971 DeWall 23-2585 OTHER REFERENCESLopez-Belio et al.: High Output Bubble Oxygenator Bypass; Surgery; Vol.47; No. 5; 5/60; pp. 772- 783.

Rygg et al.: A Disposable Polyethylene Oxygenator System; ActaChirugicia Scandinavia; Vol. 112; No. 6, 5/67; pp. 434-436.

BARRY S. RICHMAN, Primary Examiner US. Cl. X.R.

55-255, 256; 128-DIG. 3; -1.8; 261-122, DIG. 28

